PROSPECTIVE FOLLOW-UP OF HIV-INFECTED ADU LTS - 4-YEAR REPORT OF THE MULTICENTRIC FRENCH COHORT

Objectives: A prospective multicentric epidemiological study (SEROCO) of subjects with a diagnosis of human immunodeficiency virus (HIV) inf ection was started on January 1, 1988 in order to better understand th e natural history of HN infection and factors related to outcome. Obse rvations after 4 years of follow-up are reported here. Methods: After authorization by the French national ethics committee and the national commission for personal freedom, 18 French centres included non-haemo philiac volunteers who were asymptomatic, had had non anti-HIV treatme nt and whose HIV positivity had been known less than 1 year at inclusi on. These last three criteria were not required for patients whose pre cise date of contamination was known within a range of +/- 3 months. R esults: On July 15, 1992, there were 1453 infected subjects in the coh ort (1063 males, 417 females; age range at inclusion 18-75 years; mean age 31.3 +/- 9.4). Globally, 2.7% of the subjects were symptomatic at inclusion. Mean CD4 lymphocyte count at inclusion was 508/mm(3). Clin ically, 51.5% of the patients had a history of sexually transmitted di sease at inclusion. After I years (on July 15, 1992) mean follow-up wa s 28 +/- 12.9 months for a total of 3428 patient-years. Disease progre ssion to stage IV was observed in 439 patients including 202 who devel oped the acquired immuno-deficiency syndrome (AIDS). Among these 202 p atients, 113 had died at the end-point of this report. The first manif estation of AIDS was Kaposi sarcoma in 44, pulmonary pneumocystosis in 38 and cerebral toxoplasmosis in 27. The probability of developing AI DS was calculated at 13.9% at 5 years, 27.7% at 7 years and 33.7% at 1 0 years, The probability of a CD4 count below 200/mm(3) was 32.7, 55.6 and 67% at 5, 7 and 10 years respectively. For patients with a CD4 co unt below 200, the probability of developing AIDS was 18% at 1 year, 3 9% at 2 years and 51% at 3 years. Conclusions: SEROCO has been a most useful prospective epidemiological tool due to the diversity of the su bjects included. The observed natural history of HIV infection will le ad to specific research projects aimed at better understanding the dis ease process.